Viewpoint: The Nuka model of care - healthcare improvement fresh from Alaska

If you're in need of some inspiration for redesigning your local healthcare system, or simply want to get as far away as possible from your CCG offices, then can I suggest a trip to Alaska?

The Nuka System of Care, which has transformed the lives of the Alaska Native population in the area around Anchorage, is fast becoming a phenomenon of global significance to healthcare policymakers.

And every year, in June, the Southcentral Foundation, which developed the system, holds a week-long conference for anyone who wants to find out more about how it achieves ‘wellness’ in the population.

Nuka is an Alaska Native word used for ‘strong, giant structures’ and ‘living things’. In short, this team-based care model relies on highly motivated staff, strong personal relationships and the development of infrastructures that work together.

The system has the blessing of US healthcare improvement guru Professor Don Berwick, who was singing its praises in a speech in London last month: ‘Their quality scores are as good as I’ve ever seen’, he said. ‘And the morale of the employees, and the satisfaction levels of patients and their families, have never been higher.’

Professor Berwick used to live in Alaska, so he knows the system well and will be speaking at this year’s conference. He quoted some of the impressive results achieved by Nuka within the ‘difficult, impoverished’ population of 50,000 Alaska Natives, during the period 2004-9:

  • 50% decline in A&E visits
  • 53% decline in hospital bed days
  • 65% decline in the use of specialists
  • 20% reduction in the use of primary care

The foundation puts tremendous emphasis on the relationships between staff members, and between staff and the resident population – and they specifically aim for these relationships to endure across generations.

There are obvious similarities with the ‘family’ doctor model in the UK, and relationships built up between long-serving practice staff and between GPs and their favoured consultants. But is that a specific goal of our system?

Nuka shows that structure is vital to achieving integrated care, but personal relationships are the glue that binds the system together, and the oil that keeps the wheels turning, and the spark that makes things happen.

So, who’s feeling ready for a breath of Alaskan fresh air?

  • Colin Cooper is Editorial Director for GPonline

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